Excerpt: Dr. David Amies' new book on assisted dying in Canada

As a former regular contributor to the Dying With Dignity Canada blog, and an active member of both our Physicians Advisory Council and our Lethbridge chapter, Dr. David Amies has solidified his reputation as a leading commentator on medical assistance in dying (MAID) and end-of-life issues. Now, he's sharing his expertise in a newly released book, Medical Aid in Dying Canada 2017, which takes a closer look at the history of MAID in Canada, the state and implementation of Canada's assisted dying law and its possibilities for the future.

Dr. Amies has graciously shared an excerpt from his book on our blog — read it below!

Many remarkable developments in medical practice have taken place since the introduction of antibiotic drugs and safe blood transfusion. These measures are 80 to 90 years old. The discovery of insulin for the treatment of diabetes, organ transplantation, great improvements in anaesthetic and surgical techniques, advances in medical imaging and laboratory testing, with effective chemotherapy and radiation for cancers and the development of many sophisticated new drugs for the treatment of diseases previously beyond the reach of available therapies changed the relationship between medical practitioners and their patients. Improvements in public health, the widespread use of vaccinations, encouragement for people to undertake regular mental and physical activity, better dental care and understanding the science behind nutrition have all played important roles. Public warnings about the dangers associated with tobacco smoking, overindulgence in alcohol and the use of recreational drugs have likewise contributed to longer lives and better health. The intricacies of the human genome have been largely unraveled thereby enabling diagnosis of several diseases at the cellular and even the molecular level.

These advances in the understanding of disease and medical science have led to a remarkable increase in longevity around the world, but especially in the West. Newborn, white girls and boys from reasonably affluent backgrounds can expect to live well into their 80s. A very recent study suggests that the expectation of life for European women will break the 90-year barrier within the next few years. The number of people alive today who will become centenarians is also increasing. An unwanted consequence that comes with a greatly increased life expectancy is the likelihood of suffering from some kind of dementia. That and the great increase of frail elderly persons are already placing great strains on healthcare systems around the world.

Dr. David Amies' new book aims to trace the history of Canada's assisted dying law and its possible future.

Before the Second World War and the development of these new techniques and treatments, medical practitioners, for the most part, were helpless. They could provide simple surgery for broken bones, appendicitis, the draining of abscesses and the removal of gallstones, for example. Otherwise, the principal tools at their disposal were prolonged bed rest, fresh air, ineffective tonics and supportive kindliness. Once the new measures were freely available, the general public and the medical profession became partners in an unspoken conspiracy, which cast doctors in the role of supermen and women, for it appeared as if just about any medical problem could be solved. The need to discuss the possibility of death resulting from illness receded. Death came to be considered as a failure of technology and not the inevitable conclusion to all lives.

Doctor knows best?

The doctors of half a century ago did not discuss details of illnesses and treatment with their patients. They went to great lengths to conceal from them the implications of their diagnoses. They tried very hard to avoid using such words as cancer, stroke and paralysis. During this era, ordinary men and women did not question experts, preferring to accept their opinions as gospel. The pervasive motto of the day was, “Doctor knows best”. Latterly, this kind of doctor-patient relationship, which seems almost quaint today, has changed. Members of the public expect to play an important role in the management of their diseases. Doctors are now taught to take their patients into their confidence and to explain in detail what ails them and the various treatment options available. By means of enhanced communication and the Google search engine, many patients are very well informed about their conditions and very keen to ask searching questions of their doctors. Gradually, they are coming to see and accept that their physicians are not magicians and that death is something we must all anticipate.

An increased number of better informed, elderly people suffering from the many varied degenerative diseases associated with ageing, leads inevitably to an interest in knowing how to control the end of one's life. Elderly folk, who have outlived their friends and family, and who discover that their horizons are becoming more and more limited through age-related disability, but who can expect several more years of the same, have started to ask questions of the medical profession and society as a whole about the value of their existence. Good quality life, with the ability to look after oneself, to get around, to take part in a variety of activities, to enjoy the company of several generations of the family, is not something to abandon capriciously. On the other hand, a life limited to one's bedroom, boredom, inactivity, aches and pains along with the loss of personal independence is another matter altogether. It is not for nothing that care homes for the elderly are colloquially known as God's waiting rooms.

It has always been an important part of the doctor's role to provide symptomatic relief to those who are nearing the end of their lives. This relief has included alleviation of pain, nausea, anxiety and breathlessness among other things. Powerful drugs, which are effective against such symptoms, have been available for many years. Of course, such agents must be used advisedly. The difference between an effective dose and a lethal one is often very small. The relief of symptoms alone, without any thought towards fundamental cure, is known as palliation. During the past couple of decades, the medical specialty of palliative care has come into being. Its practitioners are well-trained to employ a variety of techniques that ease pain and other suffering, thereby allowing the patient to spend his or her last days or weeks relatively comfortably. Palliative care specialists work in teams and employ the resources provided by physiotherapists, nurses, music and art therapists and religious councilors, such as priests, imams and rabbis, where appropriate. Ideally, as much of this kind of care as possible is carried out in the patient’s home. If the level of care required is too complicated then admission to specialised palliative care units is available.

Unfortunately, only about 20 per cent of Canada’s population has ready access to such units. This alarming shortfall is due partly to the novelty of organised palliation as well as the increased longevity of the population causing an increased need. Surveys carried out among the Canadian medical profession have revealed a great reluctance in the palliative care community to embrace the idea of medical aid in dying or euthanasia. Furthermore, such surveys demonstrate that only one-third of all physicians are willing to take part in physician-assisted dying. Surveys of general practitioners show that about 40 per cent of them would be prepared to perform physician-assisted dying or to refer a patient, who made a request for it, to another willing colleague.

Dying With Dignity Canada thanks Dr. David Amies for sharing this excerpt of his book on our blog. To purchase Medical Aid in Dying Canada 2017, please click here


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